Consider Medication Complexity in Patients with Heart Failure

JUNE 08, 2017

Jeannette Y. Wick, RPh, MBA, FASCP

Hospitals across the nation are focusing on patients who have heart failure (HF), and are discharged and readmitted to the hospital within 30 days. From the wealth of information that we have already acquired, it's clear that these patients need support from hospital staff and from conveniently located health care professionals in the community. Community pharmacists have a significant role in increasing the likelihood that patients will remain at home—and healthy—after discharge.

A team of researchers from Houston Methodist Hospital and the University of Houston in Texas has published a study that looks at 1 factor very closely: discharge medication complexity. They employed a tool to determine each patient’s medication complexity, and then looked at potential associations with readmission to the hospital.

The results indicated that 30-day HF readmission is more likely in patients whose medication complexity scores are high.

The Medication Regimen Complexity Index (MRCI) is a tool used to factor a number of characteristics into a complexity score. In short, it establishes medication burden. Today, it's been used in chronic obstructive pulmonary disease and to prove that more complex regimens are closely associated with adverse drug events.

The researchers noted that in HF, most patients are prescribed drugs from at least 6 medication classes. In addition to looking at sheer number of drugs, the MRCI considers number of medications, administration frequency, route of administration, and other directions.

The researchers demonstrated that as the MRCI increased, 30-day hospital readmission in HF patients also increased. While this finding was not unexpected, it is significant.

Patients who were most adherent to angiotensin-converting enzyme inhibitors (ACEI) or and angiotensin receptor blockers were more likely to remain at home, according to the researchers. Those with histories of coronary artery disease were at higher risk for readmission.

The researchers concluded that this is a simple analytical tool that can be incorporated into electronic medical records and could help pharmacists target patients whose medication regimens are more complex than necessary.

Pharmacists might be able to make recommendations to reduce medication burden and increase the likelihood that patients will remain in the community. They could also stress adherence to ACEIs and ARBs.

This study appears in the journal Research in Social and Administrative Pharmacy.